How state Medicaid agencies can improve maternal mental health and mortality

By Isha Weerasinghe

The combination of the pandemic and our country’s recent reckonings with racial violence have made an already unaddressed mental health crisis untenable. These elements have exacerbated poor mental health among pregnant women and new moms beyond rates that were already staggering, particularly for Black and Brown women. Isolation and a lack of social support, economic strain, lack of child care, along with recurring historical and cultural trauma due to police violence, are creating increased stress on parents and especially mothers during this period. According to the American Psychological Association, 1 in 7 mothers experience postpartum depression. However, this number is unlikely to be accurate for Black and Brown communities living in households with low incomes because of cultural stigma, screening tools that are not culturally sensitive, and a fear of retribution from child welfare agencies. All of these factors contribute to gaps in understanding the full picture of who is affected by maternal mental health concerns, ultimately barring effective service delivery.

CLASP proposes a framework for Medicaid agencies to improve maternal mental health outcomes for women of color in the new report Advancing Equity in Maternal Mental Health: Strategies for State Medicaid Programs. Our recommended steps are as follows:

1) Work with partners from a range of sectors to improve data collection across health and social metrics, including processes, use, and stratification;

2) Better understand those who are enrolled in Medicaid programs, and who is left out, focusing on state infrastructure and serious staff self-reflections using a racial equity lens; and 

3) Together, with sector partners, develop and implement value-based initiatives that are centered around maternal health needs across race/ethnicity.

Improving maternal mental health outcomes will ultimately impact state maternal morbidity and mortality outcomes. This involves going beyond provider implicit bias trainings and other limited solutions to build on value-based models to require and incentivize equity in maternal health care. To truly work toward a value-based system that benefits all communities, Medicaid agencies have to be willing to reevaluate and ultimately reinvent systems. Broad and systemic change can address the egregious maternal morbidity and mortality rates in Black and Native women. Such a change can resolve inequities and improve maternal health across all races, ethnicities, gender identities, and sexual orientations, as well as socioeconomic, housing, and immigration statuses. 

This report provides state and federal models to improve mental health now. It also offers key questions that state Medicaid agencies must ask internally. The country’s racial reckoning alongside the public health crisis presents leaders with an opportunity to build solutions that work for everyone and help mothers get the resources to thrive.